Alcohol use problems in migraine and tension-type headache

Relationship between alcohol and primary headaches: a systematic review and meta-analysis

BACKGROUND

Headache is one of the most common neurological symptoms. Many previous studies have indicated a relationship between primary headaches and alcohol. Drinking has been associated with increased risk of tension-type headache (TTH) and migraine. However, recently published studies have not confirmed this relationship. The existing literature is inconclusive; however, migraine patients avoid alcohol. Therefore, the primary objective was to provide a reliable assessment of alcohol intake in people with primary headaches; the secondary objective was to identify any potential relationship between alcohol consumption and headache risk.

METHODS

This study was based on PubMed, Embase and Web of Science database searches performed on 11 July 2023. This systematic review was registered in PROSPERO (CRD42023412926). Risk of bias for the included studies was assessed using the Joanna Briggs Institute critical appraisal tools. Meta-analyses were performed using Statistica software. The Risk Ratio (RR) was adopted as the measure of the final effect. Analyses were based on a dichotomous division of the respondents into "non-drinkers" and "drinkers" for headache patients and matched non-headache groups.

RESULTS

From a total of 1892 articles, 22 were included in the meta-analysis. The majority demonstrated a moderate or high risk of bias. The first part of the meta-analysis was performed on data obtained from 19 migraine studies with 126 173 participants. The risk of migraine in alcohol drinkers is approximately 1.5 times lower than in the group of non-drinkers (RR = 0.71; 95% CI: 0.57-0.89). The second part involved 9 TTH studies with 28 715 participants. No relationship was found between TTH diagnosis and alcohol consumption (RR = 1.09; 95% CI: 0.93-1.27). Two of the included cluster-headache articles had inconclusive results.

CONCLUSIONS

Alcohol consumption and migraine are inversely correlated. The exact mechanism behind this observation may indicate that migraine leads to alcohol-avoidance, rather than alcohol having any protective role against migraine. There was no relationship between TTH and drinking. However, further studies related to primary headaches and alcohol consumption with low risk of bias are required. Additionally, patients and physicians should consider the latest medical data, in order to avoid the myths about alcohol consumption and primary headaches.

Assessment of Work Productivity and Activity Impairment (WPAI) questionnaire for migraine with the help of a smartphone app

BACKGROUND

Migraine is a major cause of disability, which affects many areas of life, including productivity at work. Measuring absenteeism and presenteeism resulting from migraine with the use of appropriate tools is essential for better understanding the impact of this disease.

OBJECTIVE

The aim of the present study was to assess the work impact of migraine using the Brazilian Portuguese version of Work Productivity and Activity Impairment (WPAI) questionnaire.

METHODS

This survey was carried out with the aid of a smartphone app (Dr Cefaleia for Doctors) containing the questionnaires: ID-Migraine, Headache Impact Test (HIT-6), and WPAI. The data were collected during a headache awareness event. Correlations were assessed between migraine impact (HIT-6) with WPAI parameters: a) work time missed (absenteeism), b) impairment at work (presenteeism), c) overall work productivity loss (absenteeism+presenteeism), and d) activity impairment outside work.

RESULTS

Overall, 305 subjects with headache were interviewed and 167 were classified as having migraine. No significant differences in migraine impact according to sex (p=0.8) and modality of work were registered (p=0.8). Females had significantly higher absenteeism score (p<0.001), but presenteeism score was not significantly different between genders (p=0.3). WPAI absenteeism and presenteeism scores significantly correlated with migraine impact (HIT-6).

CONCLUSIONS

The results suggest WPAI Brazilian Portuguese version was efficient in assessing migraine related work impact. The use of an app with validated questionnaires facilitates the conduction of migraine impact research in different populations, allowing a better understanding of the burden of this disease.

What the pharmacological management of migraine can tell us about the future of migraine patient care

Some of the principles of the pharmacologic management of migraine are echoed in urgent discussions of the future of headache care in the USA and around the world. From adverse events to tolerance, addiction, medication overuse and medication persistence, solutions to the pathophysiologic puzzles, and management difficulties in migraine can be found by paying closer attention to patient reports and by facilitating greater patient involvement in the treatment process. Similarly, listening to the patient as customer in the process of value-based care, so adaptable for the problem of migraine, is the solution to the health care crisis we face in so many countries.

Alcohol Use as a Comorbidity and Precipitant of Primary Headache: Review and Meta-analysis

PURPOSE OF REVIEW

In contrast to well-established relationships between headache and affective disorders, the role of alcohol use in primary headache disorders is less clear. This paper provides a narrative overview of research on alcohol use disorders (AUDs) in primary headache and presents a meta-analysis of the role of alcohol as a trigger (precipitant) of headache.

RECENT FINDINGS

The majority of studies on AUDs in headache have failed to find evidence that migraine or tension-type headache (TTH) is associated with increased risk for AUDs or problematic alcohol use. The meta-analysis indicated that 22% (95% CI: 17-29%) of individuals with primary headache endorsed alcohol as a trigger. No differences were found between individuals with migraine (with or without aura) or TTH. Odds of endorsing red wine as a trigger were over 3 times greater than odds of endorsing beer. An absence of increased risk for AUDs among those with primary headache may be attributable to alcohol's role in precipitating headache attacks for some susceptible individuals. Roughly one fifth of headache sufferers believe alcohol precipitates at least some of their attacks. Considerable study heterogeneity limits fine-grained comparisons across studies and suggests needs for more standardized methods for studying alcohol-headache relationships and rigorous experimental designs.

Headache and Alcohol

BACKGROUND

The notion that alcohol intake may trigger headache is well known. Historical data as well as clinical experience indicate that this may be the case for headache patients as well persons without known headache disorders. This monograph reviews the medical literature about alcohol as a headache trigger, what headache types are triggered, and why.

METHODS

Literature search primarily using the terms "alcohol and headache," "migraine and alcohol," "cluster headache and alcohol," and "alcohol hangover headache," as well as combined search, was performed, limiting the search to the last decade. Relevant articles were picked.

RESULTS

The search "alcohol and headache" yielded 918 hits for the decade 2004-2014. Combined search gave substantially less, and 30 papers were reviewed, of which 25 are included in this review.

DISCUSSION

Epidemiological studies find some correlations between alcohol intake and mainly primary headache disorders, such as migraine and cluster headache. Cultural differences in alcohol consumption are probably reflected in some of the results and conclusions. Both migraine and cluster headaches may be triggered by alcohol; however, which type of alcoholic beverage triggers these headaches is not clear. There is no single mechanism that explains the pathophysiology of alcohol-induced headache, other that hangover headache in some may be triggered by inactive alcohol dehydrogenase 2. Alcohol-induced headache may be diagnosed as a secondary headache, while in patients with migraine or cluster headache alcohol intake may act as a trigger for these primary headaches.

CONCLUSIONS AND RECOMMENDATIONS

Based on the literature, there is no reason to tell headache patients in general to abstain from alcohol. Individual dispositions as well as cultural factors may play a role in alcohol-induced headache.